1. Pierotti, Danielle PhD, RN, CENP

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Hardly a day goes by without some conversation, in person, in the news or in some form of social media, about the workforce in home-based care. Often the conversation is about how difficult it is to attract new nurses. Agency leaders talk about growing problems with vacancy rates, lack of applicants, and anticipated retirements. The intensity of this conversation in home-based care is mounting despite the growing supply of nurses.


At a national level, the overall number of nurses has stabilized and is projected to meet the expected need for the next several decades (HRSA, 2014). Enrollment in nursing education programs almost doubled between 2002 and 2012 bringing a much-needed influx of new and younger people into the field (Auerbach, Buerhaus, et al., 2017). We are in the middle of a dramatic shift in the average age of the nursing workforce. In 2012, just over a million of the approximately 2.5 million registered nurses were Baby Boomers. By 2025, that number is expected to fall over 65%, to just over 340,000; whereas the percent of nurses under the age of 35 will increase almost 40%, exceeding one million, in a field of now over 3.5 million (Auerbach, Chattopadhyay, et al., 2017). The Millennial generation responded to the call for nurses.


For those who study generational trends, this isn't a surprise (Anderson, 2018; Korobka, 2018). Buried in all the talk about the negatives of the generation, there are important positives to embrace. Millennials are generally defined by a shared desire to have meaningful work, are conscious of the world around them, and their impact and desire to be positive contributors to their communities. Nursing is a natural fit. It is time we connected these new nurses with home-based care. The current nursing demand is not about lack of nurses overall, but about lack of connection between nurses and the opportunities home-based care offers. The Millennial generation is known for civic commitment in a pragmatic way. They want to change the world on their terms. Terms that typically mean: flexible work schedules, clear pathways to success, acknowledgment of their progress, and opportunities to share and apply what they know, ideally working in teams. These ideas sound a lot like home-based nursing.


Successful home-based care nursing requires core skills of working in teams, listening, translating, adjusting, adapting, and being creative to achieve shared goals. Home care nurses adapt and adjust in every home because we focus on shared success. The goal is always to change the world, one patient at a time. The same skills we use to partner with new families every day are the exact skills we need to solve staffing problems. We can adjust our schedules to incorporate more flexibility. We can adapt our orientation programs to include milestones to celebrate. We can empower new team members to create new solutions. We can view these new nurses as an opportunity to cultivate stronger teams reducing the need to recruit on multiple levels.


We can focus on the unique skills Millennials bring to our shared goals and work to recruit them. They already chose nursing, now we need to bring them to the home. We need to look at recruitment and retention in home-based care as an act of nursing practice and embrace our newest peers with the same desire for shared success we bring to patient care.


DASH Ranked Best Diet Overall for Eighth Year in a Row by U.S. News and World Report

National Institutes of Health: For the eighth consecutive year, U.S. News and World Report ranked the National Institutes of Health-developed DASH Diet "best overall" diet among nearly 40 it reviewed. The announcement came just as new research suggests that combining DASH, or Dietary Approaches to Stop Hypertension, with a low-sodium diet has the potential to lower blood pressure as well as or better than many anti-hypertension medications. With its focus on vegetables, fruits, whole grains, low-fat dairy, and lean proteins, DASH, tied this year for "best overall" diet and was ranked No. 1 in the "healthy eating" and "heart disease prevention" categories.

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According to the World Health Organization, hypertension, more commonly referred to as high blood pressure, is the most common chronic condition worldwide. It is a major risk factor for heart disease, affects 1 billion people, and accounts for 1 in 8 deaths each year. Researchers funded by NIH's National Heart, Lung, and Blood Institute (NHLBI) developed DASH to prevent and treat high blood pressure, but the diet also has proven highly effective in lowering blood cholesterol.


Previous research has shown that people who follow the DASH diet may be able to reduce their blood pressure by a few points in just two weeks. Over time, their systolic blood pressure (the top number in a blood pressure reading) could drop by eight to 14 points, which significantly reduces the risk of cardiovascular disease.


The positive health effects could be even greater if DASH is combined with a low sodium diet. An NHLBI-funded study of more than 400 adults with prehypertension, or stage 1 high blood pressure, found that the combination of a low-salt diet with DASH substantially lowers systolic blood pressure. Overall, participants who started out with the highest blood pressure achieved the greatest reductions.


DASH is not a fad diet, but a healthy eating plan that supports long-term lifestyle changes. It is low in saturated fat, trans fat, and cholesterol. It emphasizes fruits, vegetables, and low-fat dairy foods, and includes whole grains, poultry, fish, lean meats, beans, and nuts. It is rich in potassium, calcium, and magnesium, as well as protein and fiber. However, it calls for a reduction in high fat red meat, sweets, and sugary beverages.




Anderson B. (2018). Four things to know about your millennial workforce. Managed Healthcare Executive. Retrieved from[Context Link]


Auerbach D. I., Buerhaus P. I., Staiger D. O. (2017). Millennials almost twice as likely to be registered nurses as baby boomers were. Health Affairs, 36(10), 1804-1807. [Context Link]


Auerbach D., Chattopadhyay A., Zangaro G., Staiger D., Buerhaus P. (2017). Improving nursing workforce forecasts: Comparative analysis of the cohort supply model and the health workforce simulation model. Nursing Economics, 35(6). [Context Link]


Korobka T. (2018). The list of millennial characteristics. Lucky Attitude; Generation Change. Retrieved from[Context Link]